Daily Briefing Blog

Not having health insurance: A top cause of preventable death?

A new paper by Ben Sommers, Kate Baicker, and Sharon Long shook the policy world on Monday by concluding that expanding health coverage significantly reduces mortality over a four-year period. Writing on the Daily Briefing blog,Dan Diamond explored the paper’s findings and the resulting debate in depth.

The takeaway: Every 830 additional people who got insurance under Massachusetts' health reforms prevented roughly one death.

But that wasn't the only report that caught my eye recently. Just last week, the CDC released a report detailing the top five causes of potentially preventable deaths in the U.S. in 2010.

Taking the two reports together made me wonder: If we consider deaths from failing to expand Medicaid as “preventable,” where would that fall?

A 2012 Urban Institute report estimated that 15.1 million uninsured adults could gain coverage if every state expanded Medicaid. Using the 830 figure from the Massachusetts study, and acknowledging that the state's coverage wasn't exactly equivalent to Medicaid, that would translate to 18,193 deaths prevented per year.

For a sense of comparison—that would make the Medicaid coverage gap the number five leading cause of preventable death in the United States:

1 “Medicaid Coverage Gap” based on 2012 estimate; other causes based on 2010 data.

The 26 states and D.C. that are expanding Medicaid are already making progress on reducing this figure. On May 1, HHS announced that enrollment in Medicaid and CHIP grew by about 4.8 million people between October 2013 and March 2014. The vast majority of this growth came from Medicaid expansion states. While we can’t definitively determine how much of this growth was because of coverage expansion, 4.8 million new enrollees would translate to slightly more than 5,700 fewer deaths, if that 830 figure from the Massachusetts study were to hold up.

But as Dan pointed out, the 24 states not expanding Medicaid represent roughly 5,790 preventable deaths under a similar calculation, and that number is not likely to move much without drastic policy changes.

Critics might point out—as they did two years ago with a similar study by authors including Sommers and Baicker—that one can’t generalize from one state’s experience to the rest of the country. Indeed, the authors of the present study clearly warn, “Massachusetts results may not generalize to other states.”

But in which way might the bias swing?

The analysis suggested that counties with lower incomes and higher pre-reform uninsured levels may see greater reductions in mortality from Medicaid expansion.

Looking back at our non-expansion states, 17 of the 24 have lower average income levels than the median state. They skew toward higher pre-reform uninsured levels as a group. And they tend to rank lower on numerous measures of health outcomes, according to a recent Commonwealth Fundreport. In other words, these might be the states that would benefit disproportionately from coverage expansion relative to Massachusetts.

And that means that the 5,790 preventable deaths figure is likely a lower bar.

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